title: Predictors of thirty-day readmission after anterior cervical fusion.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To determine the incidence of and factors predicting 30-day readmission after anterior cervical discectomy and fusion (ACDF).
  
  
  BACKGROUND
  ACDF is being performed on an increasing basis on a wider population of patients, which is accompanied by rising costs. Readmissions have the potential to further deplete health care resources. Although past studies have shown that readmissions after surgery are driven by operative complications, specific predictors of readmission after ACDF are not well researched.
  
  
  METHODS
  All patients who underwent ACDF or anterior corpectomy and fusion procedures in 2011 were selected from the American College of Surgeon's National Quality Improvement database. Readmissions were analyzed on the basis of demographics, comorbidities, operative characteristics, and complications were compared in univariate analyses. Multivariate logistic regression models were created to isolate the independent effects of preoperative and postoperative factors on readmission.
  
  
  RESULTS
  The nationwide readmission rate after ACDF surgery in this study is 2.5%. Pulmonary complications (8.5%), wound complications (8.5%), and urinary tract infections (8.5%) are the most common complications seen in readmitted patients. Readmitted patients were significantly older (58 vs. 53, P = 0.003), with higher rates of diabetes and hypertension (28.8% vs. 13.9%, P = 0.001; 64.4% vs. 42.6%, P = 0.001, respectively). Although certain preoperative factors such as age 65 years or more and preoperative stay more than 24 hours increase the odds of operative complications (odds ratio, 3.5; 95% confidence interval, 2.0-6.0 and odds ratio, 6.2; 95% confidence interval, 3.4-11.1, respectively), hypertension may independently increase the likelihood of readmission outside of any effect on complications (odds ratio, 1.8; 95% confidence interval, 1.0-3.4).
  
  
  CONCLUSIONS
  The data in this study suggests that surgeons are already controlling readmission rates by limiting peri- and postoperative complications, but patients with a history of hypertension could have an increased likelihood of being readmitted despite avoiding a complication.
  
  
  METHODS
  3.
authors.affiliation: *Northwestern University Feinberg School of Medicine, Chicago, IL †Department of Orthopaedic Surgery and ‡Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL §Rosalind Franklin University of Medicine and Science, North Chicago, IL; and ¶Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Francis
authors.initials: F
authors.lastname: Lovecchio
authors.forename: Wellington K
authors.initials: WK
authors.lastname: Hsu
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Smith
authors.forename: George
authors.initials: G
authors.lastname: Cybulski
authors.forename: Bobby
authors.initials: B
authors.lastname: Kim
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000639:trends*; D013997:Time Factors